Stimulating Brains

• #71: Harold Sackeim - The founding editor of Brain Stimulation and a founding figure in modern electroconvulsive therapy

  Today we had the privilege of speaking with a true pioneer in the field of neuropsychiatry and brain stimulation— Dr. Harold Sackeim.Dr. Sackeim is perhaps best known for his extensive research on electroconvulsive therapy (ECT), but his contributions span a wide range of topics from treatment-resistant depression to the placebo effect in neurostimulation. As a founding figure in modern ECT research, he has played a central role in shaping both the science and the clinical practice of brain stimulation therapies.In this episode, we explored the history and future of ECT, the controversies surrounding it, and Dr. Sackeim’s insights on the direction of neuromodulation. He explains how ECT has long been the most effective treatment for severe, treatment-resistant depression. While once overlooked in favor of medication, we now know that both the placement and intensity of stimulation are key—challenging the old belief that seizures alone drive its effects.

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• #70: Rees Cosgrove – When Neurosurgery Chooses You: Rediscovering the Lost Art of Lesions and the Future of Brain Stimulation

  In this episode, we journey through the remarkable career of Dr. Rees Cosgrove—a trailblazer in functional neurosurgery, Director of Epilepsy and Functional Neurosurgery at Brigham and Women’s Hospital, and Professor of Neurosurgery at Harvard Medical School.Dr. Cosgrove reflects on his formative years training in the very halls that were roamed by legends such as Wilder Penfield at the Montreal Neurological Institute, and takes us through pivotal chapters of his career leading programs at Massachusetts General Hospital, Brown University, and now the Brigham. With a repertoire that spans from the golden era of ablative neurosurgery to modern deep brain stimulation and MR-guided focused ultrasound—where he has performed over 600 sonications—Dr. Cosgrove provides a unique perspective on how the field has transformed over the past several decades.Throughout the conversation, we delve into the history and resurgence of surgical lesions for psychiatric and neurological conditions, the nuances of neuromodulation technologies, and the evolution of imaging that now defines precision in brain surgery. Dr. Cosgrove also shares his views on mentorship, the transmission of surgical wisdom, and how we can preserve the disappearing art of lesioning in an age increasingly dominated by stimulation.Whether you're a neurosurgeon, neuroscientist, or simply curious about how we interface with the brain to treat disease, this episode is a rare and insightful look into the mind of one of the field’s most experienced and thoughtful pioneers.

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  1:50:08
• #69: Terence Sanger – Pushing Boundaries in Pediatric DBS: From Multi-Electrode Stimulation to Closed-Loop Strategies

  In this episode we will dive deep into the minds of leading researchers and clinicians in the field of neuromodulation. Today, we are thrilled to have Dr. Terry Sanger with us.Dr. Sanger is a renowned pediatric neurologist, engineer, and Chief Scientific Officer at CHOC, where he focuses on improving the lives of children with movement disorders—especially dystonia. He’s well known for combining deep computational approaches with cutting-edge neuromodulation techniques.In this episode, we’ll uncover how his background in engineering, neuroscience, and clinical practice converges to shape new possibilities for treating complex movement disorders in children. From pioneering multi-electrode deep brain stimulation for pediatric dystonia to his latest forays in closed-loop stimulation research, Dr. Sanger is truly expanding the boundaries of what’s possible in pediatric care.

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  1:46:48
• #68: Todd Herrington – The Future of Neuromodulation: Insights from the ADAPT PD Trial and Beyond

  In this episode, we have the privilege of speaking with Dr. Todd Herrington, a leading neurologist and director of the Deep Brain Stimulation (DBS) program at Massachusetts General Hospital. Dr. Herrington specializes in movement disorders such as Parkinson’s disease, tremor, and dystonia, and his research focuses on the motor, cognitive, and psychiatric effects of DBS, leveraging intraoperative and noninvasive neurophysiology and neuroimaging to advance neuromodulation therapies.Today, we’ll explore his key role in the ADAPT PD trial, a groundbreaking multicenter study evaluating the safety and efficacy of adaptive DBS for Parkinson’s disease. This trial, led by Dr. Helen Brontë-Stewart at Stanford, introduced a neurostimulator capable of sensing local field potentials and dynamically adjusting stimulation in real time based on a patient’s brain activity. We’ll discuss how this technology represents a shift toward personalized DBS therapy and what it means for the future of neuromodulation.In the second part of our conversation, we’ll delve into broader topics, including the mechanism of action of DBS, novel neuromodulation approaches, and the potential role of stem cell therapy in movement disorders. Dr. Herrington shares his expert insights on how these advancements shape both our scientific understanding and the clinical application of DBS. From improving motor and non-motor symptoms in Parkinson’s disease to pioneering adaptive neurostimulation, his work is at the forefront of innovation in the field.

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  1:41:05
• #67: Jonathan Downar – TMS for Depression: Towards a One-Day protocol

  In this episode, we’re joined by Dr. Jonathan Downar, a psychiatrist and neuroscientist based in Toronto, renowned for his pioneering research in transcranial magnetic stimulation (TMS) for depression. You may recognize him from his landmark work on the Three-D Trial, which helped establish intermittent theta-burst stimulation (iTBS) as a rapid and effective alternative to standard repetitive TMS.Recently, Jonathan has been pushing the boundaries of TMS with accelerated treatment protocols, including the One-D Study, which tested the feasibility of delivering an entire TMS course in a single day.In our conversation, we explore his scientific journey, the future of brain stimulation, and his bold approach to innovation—what he calls “TMS in SpaceX mode.” We also discuss the vision for achieving a billion depression patient remissions in our lifetime.Tune in for an inspiring and insightful discussion with one of the leaders in neuromodulation research.

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